Pelvic fractures in blunt trauma patients: A comparative study.

Background: Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.

Are geriatric transfer patients with traumatic brain injury at risk for worse outcomes compared to non-geriatric? Propensity-matched study.

Objective: To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy.

Methods: A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without.

Results: Patients with TBI constituted 54.

Stop exsanguination by inflation: management of aorta-esophageal fistula bleeding.

Aortoesophageal fistula is rare and typically presents itself to the emergency department as Chiari's Triad of mid-thoracic pain, sentinel arterial hemorrhage, and exsanguination after a symptom-free interval. However, fatal bleeding may be the first and last presentation of an aortoesophageal fistula. When a patient experiences massive hematemesis without witnesses, EMS may assume that bleed is of a traumatic mechanism.

Two surgical pathways for isolated hip fractures: A comparative study.

Background: Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services.

Aim: To compare management and outcomes among patients admitted through the trauma pathway (TP) medical pathway (MP).

Diagnostic nightmare: intra-intestinal bleed masks intra-abdominal bleed after colonoscopy.

Colonoscopy is a widely used method of screening, diagnosis and intervention. Complications are infrequent and generally present as colonic perforation or colonic hemorrhage. A rare and life-threatening complication of colonoscopy is splenic injury or rupture.

The timing and value of early postoperative computed tomography after head surgery in traumatic brain injury patients.

Objective: To analyze the timing of the early postoperative computed tomography (CT) in traumatic brain injury (TBI) patients, and compare CT and neurological examination (NE) findings.

Methods: Retrospective analysis included 353 TBI patients admitted to two level 1 trauma centers (2016-2020) who underwent head surgery and postoperative CT within 24 h. Analyzed variables: age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Abbreviated Injury Scale head (AISh), comorbidities, CT and NE findings and timing, head surgery type, and mortality.

Blunt Cardiac Injury in Patients With Sternal Fractures.

Background Blunt cardiac injury (BCI) is a possible consequence of sternal fractures (SF). There is a scarcity of studies addressing BCI in patients with different types of SF and with pre-existing cardiac conditions. The goal of this study was to delineate diagnostic patterns of BCI in different cohorts of SF patients.

Sternal fractures in blunt trauma patients.

Purpose: Sternal fractures (SF) are commonly associated with other injuries and their incidence is on the rise. The aim was to evaluate injury characteristics and outcomes in patients with all types of SF after blunt trauma.

Methods: Retrospective analysis of 380 SF patients from two Level 1 trauma centers was performed.

Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations.

Background: Palliative care in trauma patients is still evolving. The goal was to compare characteristics, outcomes, triggers and timing for palliative care consultations (PCC) in geriatric (≥65 y.o.

Reduction in Potentially Inappropriate Interventions in Trauma Patients following a Palliative Care Consultation.

Palliative care is expanding as part of treatment, but remains underutilized in trauma settings. Palliative care consultations (PCC) have shown to reduce nonbeneficial, potentially inappropriate interventions (PII), as decision for their use should always be made in the context of both the patient's prognosis and the patient's goals of care. To characterize trauma patients who received PCC and to analyze the effect of PCC and do-not-resuscitate (DNR) orders on PII in severely injured patients.

Surgical Stabilization of Rib Fractures: Indications, Techniques, and Pitfalls.

Unlabelled: Rib fractures are a common thoracic injury that is encountered in 20% to 39% of patients with blunt chest trauma and is associated with substantial morbidity and mortality. Traditionally, the majority of patient with rib fractures have been managed nonoperatively. Recently, the utilization of surgical stabilization of rib fractures has increased considerably because the procedure has shown improved outcomes.

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study.

Objective: To delineate characteristics of trauma patients associated with a palliative care consultation (PCC) and to analyze the role of do-not-resuscitate (DNR) orders and related outcomes.

Methods: Retrospective study included 864 patients from 2 level one trauma centers admitted between 2012 and 2019.  Level 1 trauma centers are designated for admission of the most severe injured patients.

Intravenous Ibuprofen Reduces Opioid Consumption During the Initial 48 Hours After Injury in Orthopedic Trauma Patients.

Objectives: To evaluate the efficacy of intravenous (IV) ibuprofen (Caldolor) administration in the management of acute pain in orthopedic trauma patients and to minimize opioid use.

Design: Randomized controlled trial, double-blind, parallel, placebo-controlled.

Setting: Level 1 Trauma Center.

Early Versus Late Tracheostomy in Trauma Patients With Rib Fractures.

Background: Patients with blunt chest trauma with multiple rib fractures (RF) may require tracheostomy. The goal was to compare early (≤7 d) versus late (>7 d) tracheostomy patients and to analyze clinical outcomes, to determine which timing is more beneficial.

Methods: This retrospective review included 124 patients with RF admitted to trauma ICU at two level 1 trauma centers who underwent tracheostomy.

Outcome Analysis of Surgical Stabilization of Rib Fractures in Trauma Patients.

Objectives: To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabilization of rib fractures (SSRF) to those treated nonoperatively.

Design: Retrospective cohort study.

Setting: Two Level 1 Trauma Centers.

Evaluation of patients with surgically stabilized rib fractures by different scoring systems.

Purpose: Surgical Stabilization (SSRF) is gaining popularity as an alternative to non-operative management (NOM) of patients with rib fractures, however, there are no established guidelines for patients' quantifiable evaluation and for SSRF recommendation. Known rib scoring systems include: Rib Fracture Score (RFS), Chest Wall Trauma Score (CWTS), Chest Trauma Score (CTS) and RibScore (RS), but are underutilized. The purpose was to provide values of scoring systems in SSRF and NOM patients and correlate them with treatment assignment.

Extracellular Matrix Applications in the Treatment of Open Fractures With Complex Wounds and Large Soft Tissue Defects.

Use of biologic scaffolds such as extracellular matrix (ECM) is a promising trend in the treatment of complex wounds in orthopedic trauma patients. In this clinical series we describe the technique of the successful application of porcine urinary bladder ECM products in the treatment of open fractures of the extremities with complex wounds and large soft tissue defects. The clinical outcomes demonstrated that even in challenging cases where local flap coverage of bone or neurovascular structures is not possible, sequential xenograft implantation allowed us to achieve a stable soft tissue envelope.

Anterior referencing versus posterior referencing in total knee arthroplasty.

Appropriate femoral component positioning and sizing is essential for proper kinematic function in total knee arthroplasty (TKA). Anterior or posterior referencing (AR or PR) are two major techniques for setting center of rotation and for balancing the sagittal plane of the arthroplasty. Both techniques have advantages and disadvantages.

Incidence of bicompartmental osteoarthritis in patients undergoing total and unicompartmental knee arthroplasty: is the time ripe for a less radical treatment?

We sought to determine the incidence of bicompartmental osteoarthritis among knee replacement patients for possible bone-sparing procedures. In 259 consecutive Knee Registry subjects undergoing total or unicondylar knee arthroplasty, all three compartments of the knee joint were evaluated. Radiographic images and preoperative cruciate ligaments assessment combined with intraoperative cartilage grading using Outerbridge classification was implemented for patients' evaluations.

Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium.

Comparisons between mini-midvastus (mMV) and mini-medial parapatellar approach (mMPP) for total knee arthroplasty (TKA) have reported variable results. We compared two approaches with minimum two year follow up. Forty consecutive patients who underwent staged bilateral TKA were prospectively randomized for mMPP approach in one knee and mMV approach in the other.

Function related specifications for total knee arthroplasty implant devices.

Current specifications for total knee implant devices reflect components' properties separate from each other and often in noncomparable units. We can recognize the tibial base plate thickness, size of femoral component, etc. How does it reflect the functional capabilities of the whole assembly, particularly in relation to wear and survivorship? Such approach does not take into account the fact that the individual components interact with each other, which in turn defines the final evaluation.

Thoracic defects: cleft sternum and Poland syndrome.

Defects of the thoracic cage with bone and/or muscle deficit are relatively rare and can present a real risk depending on the severity of manifestations. Cleft sternum results from failed midline fusion of the sternal halves that leaves the heart and great vessels unprotected, and is commonly associated with craniofacial hemangiomas. Correction is recommended during the neonatal period when compliant thorax allows direct suturing of the divided sternum.

Surgical repair of pectus excavatum and carinatum.

The author discusses different forms of pectus deformities and presents appropriate surgical methods he developed for their correction. For pectus excavatum, the surgical technique includes conservative sub-perichondral resection of deformed costal cartilages and detachment of the xiphoid process. A transverse sternotomy is performed at the upper level of the deformed sternum, which is then bent forward.

Anatomical, histologic, and genetic characteristics of congenital chest wall deformities.

There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations.